Special Considerations for Psychological/Educational Evaluations of Children with No Speech or Unintelligible Speech

By Ellen B. Braaten, Ph.D., and Gretchen Felopulos, Ph.D.

The first thing to keep in mind when testing children with significant speech delays is that most standardized tests of intelligence will either be inappropriate or of questionable validity. Because language is such an important component of most tests of intelligence, it is nearly impossible to validly give those tests (such as the WISC-IV or WPPSI-III) in their entirety to children with significant communication disorders. That doesn’t mean that they aren’t given, and often they are given with good reason. However, the first consideration to keep in mind is that they would, at best, provide a crude comparison of a child’s ability in certain areas. The second consideration (and most important), is that these types of tests should never be used to make predictions about a severely language impaired child’s eventual functioning. We have evaluated countless children who were originally diagnosed with autism, mental retardation, or a pervasive developmental disorder because their scores on an intelligence test were impaired due to basic communication problems (either expressive or receptive or both).

Because language disorders vary widely in nature and are seen in a wide range of individuals from early childhood throughout adulthood, assessment is never simple and is often idiosyncratic. Keeping that in mind, there are some assessment considerations that can be somewhat generalizable. First, the examiner can modify the assessment to provide additional cues or assistance for the child (sometimes called “testing the limits”). Second, the examiner can pick certain tests that rely less on verbal skills.

“Testing the limits” occurs when an examiner goes beyond standard test procedures to gain additional information about a child’s abilities. Generally, examiners make few modifications when administering standardized tests because the tests are designed to be given in exactly the same way to each child. However, when a child has little or no speech or poor receptive language skills, we might modify instructions, modify the response format (e.g., allowing pointing instead of oral responses), or, in cases where the child’s speech is difficult to understand, allow the parents to serve as “translators.” Children with significant oral language problems should be allowed to use any means to communicate, including writing, typing, using a computer or another augmentative communication devise, pointing to letters, signing or gesturing. The information obtained when “testing the limits,” such as whether the child benefited from verbal cues, pointing, or repeating instructions, is often helpful in planning interventions. When tests are modified in this way, standardized norms can only be used as a rough guide and the results provide just an approximation of a child’s ability level.

In addition to these considerations, there are a number of assessment instruments that are designed for children with significant communication disorders. The Leiter-R, the Comprehensive Test of Nonverbal Intelligence, Raven’s Progressive Matrices, the Universal Nonverbal Intelligence Test (UNIT) and the Test of Nonverbal Intelligence (TONI-III) can be validity administered without having the child provide an oral response. The UNIT is administered using language-free gestures. Other good nonverbal tests include the Processing Speed and Perceptual Organization subtests from the WISC-IV, the Abstract/Visual Reasoning subtests of the Stanford Binet-IV, and the Spatial and Nonverbal Reasoning Clusters of the Differential Abilities Scale (DAS). Receptive language tests with multiple-choice picture responses include the OWLS Listening Comprehension Scale and some of the subtests from the Comprehensive Assessment of Spoken Language (CASL).

In general, when evaluating children with significant language impairments, the psychologist should tailor the assessment to the child’s individual functional needs or disabilities. Using a wide range of assessment instruments and using other sources of data such as observational and parent and teacher reports is crucial. While standardized tests are useful, more informal clinical judgments are important in these cases as well.

[Drs. Ellen Braaten and Gretchen Felopulos are the authors of Straight Talk About Psychological Testing for Kids. They are both on the faculty of Harvard Medical School and are child psychologists at the Massachusetts General Hospital. In addition, they have a private practice in Lexington, Massachusetts. Their web site, www.kidtesting.com, offers more information related to testing children with special needs.]

This web site is a program of the Childhood Apraxia of Speech Association, the national organization representing the needs and interests of children affected by apraxia of speech.
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